Book Review of Insulin – The crooked timber

Arpan K. Banerjee
Solihull, United Kingdom

 

Cover of Insulin - The Crooked Timber by Kersten T. Hall for this book review
Cover of Insulin – The Crooked Timber: A History from Thick Brown Muck to Wall Street Gold by Kersten T. Hall.

The title of this interesting book is taken from the German philosopher Immanuel Kant, who wrote that: “Out of the crooked timber of humanity no straight thing can ever be made.” It is applicable to the tortuous way scientific discoveries are made and is particularly pertinent to diabetes and the development of insulin.

Diabetes was first recognized by the ancient Egyptians and mentioned in the Ebers papyrus at about 1550 BCE. The sixth century BCE Hindu physician Sushruta was aware of this condition in which urine tasted sweet. In the second century CE, Aretaeus of Cappadocia named the condition “diabetes.” Thomas Willis, the seventeenth-century British physician best remembered for his eponymous Circle of Willis also described it, calling it “the pissing evil” in his 1674 textbook Pharmaceutica Rationalis.

Diabetes has been a significant cause of illness for centuries, not treatable until the discovery of insulin in 1921-22. In its commercial form insulin became available in 1923. This year marks a century since the discovery of insulin by Banting and Best in Toronto. Author Kersten Hall, a molecular biologist and science historian, wrote this history of the discovery of insulin after he himself developed type 1 diabetes. It is a good read and scholarly account, covering the discovery of insulin by Banting and Best and the controversial awarding of the 1923 Nobel Prize in Medicine to John McLeod, who subsequently shared his portion of the prize with the biochemist James Collip who purified insulin. Contributions from other scientists are also reviewed, such as those of Germans Minkowski and von Mering, who in 1889 demonstrated the role of the pancreas in insulin production.

We also learn about researchers such as Paulescu from Romania, who also laid claim to the discovery of insulin, and others who did groundbreaking work in the field. Ultimately, the accolades of discovery were given to Banting and Best with McLeod in Toronto for their experiments to extract insulin (“thick brown muck” as it was called) from the pancreas of a dog. The controversy over awarding the Nobel Prize to McLeod and not Best is discussed in detail. The role of Eli Lilly and the early manufacture of insulin is also described, along with later advances in molecular biology and biochemistry throughout the twentieth century that led to the synthesis of human insulin. The involvement of pharmaceutical and modern biotech companies reminds us of the interplay between science, business enterprise, and healthcare economics in development of new treatments.

This book tells the story of the complex personalities who made advances in biochemistry and molecular biology that enabled the development of better insulin products. This has allowed people with diabetes to live long and fulfilling lives instead of dying prematurely. The lengthy bibliography and endnotes are a testament to the extensive research that has been carried out to produce this fascinating account.

 

Insulin – The Crooked Timber: A History from Thick Brown Muck to Wall Street Gold
Kersten T. Hall, Oxford University Press 2022
ISBN 9780192855381

 


 

DR. ARPAN K. BANERJEE qualified in medicine at St Thomas’s Hospital Medical School. London. He was a consultant radiologist in Birmingham 1995-2019. He was President of the radiology section of the RSM 2005-2007 and on the scientific committee of the Royal College of Radiologists 2012-2016. He was Chairman of the British Society for the History of Radiology 2012-2017. He is Chairman of ISHRAD. He is author/co-author of papers on a variety of clinical, radiological, and medical historical topics and seven books, including Classic Papers in Modern Diagnostic Radiology (2005) and The History of Radiology (OUP 2013).

 

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